Tibia Fracture in Staged Limb Salvage Using External Ring Fixation and Intramedullary Nailing: A Report of Two Cases.

Limb salvage for Charcot's neuroarthropathy has been shown to have high complication and failure rates. The aim of our report of two cases it to present a unique complication encountered with staged limb salvage for Charcot's neuroarthropathy. In two cases, patients developed delayed tibial shaft fracture associated with previous wire placement despite insertion of locked intramedullary nail fixation that spanned the delayed fracture. Both patients experienced fractures following advancement of weight after definitive fixation. In both patients, there was noted complication with the sites of the pins and revision of external fixation before fracture. In each case, the fracture was within the construct of the intramedullary fixation and successfully treated with an extended course of nonweightbearing. Complications of external fixation and intramedullary fixation are well reported within the literature; however, tibia fracture is rare. Based on these cases, it would seem prudent to recognize the risk of delayed pin-site complications and ensure adequate length of intramedullary fixation to span the potential areas of stress.

Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series.

Retrograde intramedullary nails are often used for tibiotalocalcaneal arthrodesis to correct severe hindfoot deformities in high-risk patient populations. The purposes of the current study are to report outcomes of patients undergoing staged management of infection after intramedullary nail fixation for tibiotalocalcaneal arthrodesis and to review the surgical approach to management of this limb-threatening complication. The authors reviewed patients who underwent hindfoot intramedullary nailing with subsequent revision for infection between January 2006 and December 2016. Staged protocol with antibiotic nail for the management of deep infection was used in 19 patients. The mean follow-up was 115.87 ± 92.80 (range 2.29 to 341.86) weeks. Twelve of the patients had diabetes, 10 had Charcot neuroarthropathy, and 7 had arthrodesis for equinovarus deformity. Sixteen had peripheral neuropathy and 13 had history of ulceration on the operated extremity. Limb salvage with the use of this protocol was achieved in 14 (73.68%) of 19 patients. Five (26.32%) patients had proximal amputation with 3 (15.79%) deaths within the follow-up period. Amputation was more likely in the nonsmoking (p = .01) and insulin-dependent (odds ratio = 22, p = .02) patient cohorts, whereas death was associated only with higher body mass index (p = .03). Time to revision was greater in patients with external bracing postoperatively as well (p = .004). Outcomes, including total number of procedures and retained antibiotic rods, were not associated with any of the preoperative variables or indications. In high-risk patient populations, the presented staged management of infected intramedullary hindfoot nails showed promising outcomes for limb preservation.

Acute Compartment Syndrome of the Foot Due To Frostbite: Literature Review and Case Report.

Acute compartment syndrome of the foot and ankle is a relatively rare clinical finding. Lower extremity compartment syndrome is customarily due to vascular or orthopedic traumatic limb-threatening pathologic issues. Clinical correlation and measurement of intracompartmental pressure are paramount to efficient diagnosis and treatment. Delayed treatment can lead to local and systemically adverse consequences. Frostbite, a comparatively more common pathologic entity of the distal extremities, occurs when tissues are exposed to freezing temperatures. Previously found in military populations, frostbite has become increasingly prevalent in the general population, leading to more clinical presentations to foot and ankle specialists. We present a review of the published data of acute foot compartment syndrome and pedal frostbite, with pathogenesis, treatment, and subsequent sequelae. A case report illustrating 1 example of bilateral foot, atraumatic compartment syndrome, is highlighted in the present report. The patient presented with changes consistent with distal bilateral forefoot frostbite, along with gangrenous changes to the distal tuft of each hallux. At admission and evaluation, the patient had increasing rhabdomyolysis with no other clear etiology. Compartment pressures were measured in the emergency room and were >100 mm Hg in the medial compartment and 50 mm Hg dorsally. The patient was taken to the operating room urgently for bilateral pedal compartment release. Both pathologic entities have detrimental outcomes if not treated in a timely and appropriate manner, with amputation rates increasing with increasing delay.